Thyroid carcinoma follow-up: tertiary to primary care transition in Portugal

The transition of differentiated thyroid carcinoma (DTC) care from hospital to primary care remains controversial. Current studies suggest that low-risk patients with an excellent response to therapy are safely followed up by primary care professionals. Despite this, discharge practices among Portuguese thyroidologists remain heterogeneous and the success of this clinical transition is yet unknown. This study aims to evaluate primary care compliance to follow-up recommendations for DTC patients after tertiary care discharge.

A retrospective observational study was conducted including individuals with a history of DTC who were treated in a Portuguese tertiary care hospital and discharged to follow-up at primary care setting, during 2022. Data were collected from electronic records, including thyroglobulin and antithyroglobulin antibody levels.

A total of 134 individuals were discharged. The majority (n = 105; 78.4%) were female, with a mean age at discharge of 64 ± 12 years. The most frequent diagnosis was papillary thyroid carcinoma (95.5%, n = 128). Regarding treatment, 52.2% (n = 70) only underwent thyroidectomy, 44.8% (n = 60) underwent thyroidectomy followed by iodine-131 ablation, and 3.0% (n = 4) underwent subtotal thyroidectomy. Most DTC cases (86.6%, n = 116) were classified as low risk and showed an excellent response to treatment (82.1%, n = 110) according to the ATA 2015 Guidelines. One year after discharge, biochemical response evaluated by thyroglobulin and antithyroglobulin levels were registered in 29.1% (n = 39) of individuals. Thirteen patients (9.7%) had records of either antithyroglobulin antibodies or thyroglobulin alone.

Patients with low-risk DTC receive suboptimal monitoring after transition to primary care, emphasizing the need to enhance follow-up practices to ensure adequate long-term surveillance.